Hispanics are insufficiently involved in recent advances in cancer prevention, treatment, and control. They are subject to significant barriers to screening and early detection and, due to cultural gaps, they are often not well-served in clinical care and follow-up. There are relationships between acculturation and behavioral risks such as smoking or heavy drinking and a mix of positive and negative nutritional patterns. Hispanics also are subject to particular environmental and occupational risks. Communication and education for Hispanics needs to be culturally sensitive and appropriate for diverse sub-populations. Health care settings, schools, worksites, and other community settings provide potential channels for involving Hispanic populations in cancer treatment, control, and prevention. University and service research organizations can guide advances in these areas by conducting local demonstration projects that serve as models for systematization, dissemination, and institutionalization in defined populations of agencies and organization. To accelerate the participation of Hispanic populations in research and action, a national Hispanic Leadership Initiative on Cancer is proposed to conduct outreach research. This work will include local demonstration projects and regional dissemination studies and coalition-building/policy advocacy at the local, state, and national level. This program of outreach activities will be implemented through demonstration/dissemination centers in Texas, California, Florida and New York and will be planned by working groups organized to guide the major areas of activity. The Principal Investigator and Co-Investigators (directing work at each site) and Co- Investigators leading working groups have a combined background of experience and expertise that crosses all relevant areas of cancer prevention, control, and treatment. In a process that will bring national and regional experts in medicine and public health together with local and "grass roots" community leaders, the centers will engage diverse Hispanic sub-populations in these areas of cancer control: 1) examination of epidemiological trends/setting of objectives; 2) improvement in screening and access to care and in cultural sensitivity of care; 3) improvement in nutrition; 4) awareness and modification of behavioral and environmental risks; 5) demonstration research and outreach evaluation; and 6) coalition-building for dissemination, institutionalization, and policy advocacy. The specific research activities at each site are to: 1) construct a research design at the local level with demonstration and comparison areas; 2) identify defined populations at the level of organizations and institutions for assessing dissemination, institutionalization, and policy impact; 3) measurement of cancer rates and trends; 4) evaluation of screening and clinical care services; 5) assessment of behavioral and environmental risks; 6) collection and reporting of qualitative and historical data. The demonstration activities will involve: 1) community organization; 2) educational groups; 3) health care provider programs; and 4) media and public communication. The dissemination activities for each region are: 1) training and technical assistance; 2) continuing education, advanced professional education, and programs to recruit Hispanic students; 3) provision of a research directory, and 4) coalition building for institutionalization and policy advocacy.